Healthcare Provider Details

I. General information

NPI: 1598854739
Provider Name (Legal Business Name): THIEN DUC TRUONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S DECATUR BLVD
LAS VEGAS NV
89102-8510
US

IV. Provider business mailing address

1350 S DECATUR BLVD
LAS VEGAS NV
89102-8510
US

V. Phone/Fax

Practice location:
  • Phone: 702-870-1350
  • Fax:
Mailing address:
  • Phone: 702-870-1350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4494
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number50110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: